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HAI-AC: Central Line Insertion Practices (CLIP) Option 1: fill out all asterisked data points on CLIP form Option 1: fill out all asterisked data points on CLIP form –In ICUs x 6 months OR Option 2: fill out 6 areas AND do outcome module for one ICU unit OR Option 2: fill out 6 areas AND do outcome module for one ICU unitAND Documentation of daily assessment of line necessity by a clinician. Documentation of daily assessment of line necessity by a clinician.

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Details of Option 2 Demographics plus: Occupation of inserter Occupation of inserter Hand hygiene performed prior Hand hygiene performed prior Used sterile barrier precautions? Used sterile barrier precautions? Type of skin prep Type of skin prep Location of insertion site Location of insertion site Type of CL inserted Type of CL insertedAdvantages: CA data contributed to national database CA data contributed to national database Not that much more work Not that much more workDisadvantages: CA data not part of national database CA data not part of national database Must do additional outcome reporting Must do additional outcome reporting

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AFL 08-10 Frequently Asked Questions (FAQs) With the requirement for daily assessment of line necessity, who must perform the assessment? Can it be an RN? With the requirement for daily assessment of line necessity, who must perform the assessment? Can it be an RN? –The line must be assessed by a licensed practitioner for whom ordering a line or discontinuation of a line is in their scope of practice. An RN can do so only if licensed for advanced practice. Does assessment of necessity need to be documented for each line in an individual patient? Does assessment of necessity need to be documented for each line in an individual patient? –As multiple lines are counted as one line day, multiple lines can be covered under one assessment note. –It is not required to document compliance in the medical record. You must be able to show a surveyor documentation of assessment for a particular date if requested. –There is no requirement to collate compliance data.

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AFL 08-10 FAQ – Slide 2 Who must document that the assessment was completed? Who must document that the assessment was completed? –Your hospital policy may direct this process. It is not required to be the physician. See next slide for example of issues your policy/procedure might cover. What happens if a patient has their central line inserted in Radiology – do we have to fill out the CLIP form? What happens if a patient has their central line inserted in Radiology – do we have to fill out the CLIP form? –The current CLIP monitoring requirement is for all central lines inserted in ICUs (including PICUs and NICUs) between July 08 and Dec 08. Monitoring of other areas where lines are inserted is your option. –At this point, monitoring for line necessity is required for patients w/ lines who are in ICUs only.

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Issues Suggested for Inclusion in Assessment Procedure Issues Issues –assessment done by physician during rounds, during multidisciplinary rounds, … –where/how assessment should be documented –who can sign off that assessment has been done –what should be included in sign-off There is no intent for CDPH to be more proscriptive of this process beyond that it must be done in tandem w/ CLIP reporting. There is no intent for CDPH to be more proscriptive of this process beyond that it must be done in tandem w/ CLIP reporting. There is no requirement that compliance data for daily assessment of central line necessity be compiled or reported by a facility. There is no requirement that compliance data for daily assessment of central line necessity be compiled or reported by a facility. L&C may ask to look at your facility’s procedure and/or evidence of implementation. L&C may ask to look at your facility’s procedure and/or evidence of implementation.

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AFL 08-10 FAQs – Slide 3 Do instructions in Attachment #3 supersede what is written in the actual AFL? Do instructions in Attachment #3 supersede what is written in the actual AFL? –No – NHSN module instructions DO NOT supersede AFL directions What do we need to do about our monthly “plan”? What do we need to do about our monthly “plan”? –Option 1: sign up to report CLIP module in all ICUs –Option 2: sign up to report BSIs in one ICU; report 6 data points in CLIP module for all central lines inserted in all ICUs; this is outside your plan Mask/eyeshield is to be interpreted as mask OR mask and eye shield; there is no requirement for the inserter to wear goggles Mask/eyeshield is to be interpreted as mask OR mask and eye shield; there is no requirement for the inserter to wear goggles

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AFL 08-10 – Miscellaneous There is an asterisk on some versions of the NHSN draft CLIP form. This is an error and should be corrected in the final version. There is no requirement to report patient names. There is an asterisk on some versions of the NHSN draft CLIP form. This is an error and should be corrected in the final version. There is no requirement to report patient names. Please use MRN as primary ID, not secondary as stated in the AFL Please use MRN as primary ID, not secondary as stated in the AFL